Dianne L. Chambless

Defining Empirically Supported Therapies

A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious. The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatments efficacy are sound. It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.

Reliability and validity of the beck anxiety inventory

Abstract Two studies were conducted to further psychometric research on the recently developed Beck Anxiety Inventory (BAI). In Study 1 the test-retest reliability and internal consistency of the scale were examined with a sample of 40 outpatients having anxiety disorders. The BAI proved highly internally consistent (cronbachs alpha = .94) and acceptably reliable over an average time lapse of 11 days (r = .67). Study 2 was conducted to assess the convergent and discriminant validity of the BAI vis a vis anxiety and depression and in comparison to the widely used trait Anxiety measure from the State-Trait Anxiety Inventory. Seventy-one outpatients with anxiety disorders completed the revised State-Trait Anxiety Inventory, the Beck Depression Inventory, and daily diary ratings of anxiety and depression in addition to the BAI. The BAI fared better on tests of convergent and discriminant validity than did Trait Anxiety. The correlation between the BAI and Diary Anxiety was significantly higher than that between BAI and Diary Depression, and, compared to Trait Anxiety, the BAI was significantly less confounded with depression as measured by the BDI. Scores for STAI-Y Trait Anxiety were highly confounded with measures of depression, but results for the STAI-Y State scale were more positive.

Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis

A meta-analytic comparison of studies testing cognitive behavior therapy (CBT; n = 12) and exposure treatment (n = 9) for social phobia indicates that the treatment modalities are equally effective. Compared to exposure, CBT did not lead to greater pretest-posttest or pretest-follow-up improvement on self-report measures of social anxiety, cognitive symptoms, or depressed/anxious mood. Length of treatment was generally unrelated to outcome, although a larger number of exposure sessions produced better results on measures of social anxiety at posttest.

More information from fewer questions: The factor structure and item properties of the original and Brief Fear of Negative Evaluation scale

Statistical methods designed for categorical data were used to perform confirmatory factor analyses and item response theory (IRT) analyses of the Fear of Negative Evaluation scale (FNE; D. Watson & R. Friend, 1969) and the Brief FNE (BFNE; M. R. Leary, 1983). Results suggested that a 2-factor model fit the data better for both the FNE and the BFNE, although the evidence was less strong for the FNE. The IRT analyses indicated that although both measures had items with good discrimination, the FNE items discriminated only at lower levels of the underlying construct, whereas the BFNE items discriminated across a wider range. Convergent validity analyses indicated that the straightforwardly-worded items on each scale had significantly stronger relationships with theoretically related measures than did the reverse-worded items. On the basis of all analyses, usage of the straightforwardly-worded BFNE factor is recommended for the assessment of fear of negative evaluation.

Cognitive-Behavioral Therapy for Adult Anxiety Disorders in Clinical Practice: A Meta-Analysis of Effectiveness Studies

The efficacy of cognitive-behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized. Meta-analytic effect sizes are presented for disorder-specific symptom measures as well as symptoms of generalized anxiety and depression for each disorder, and benchmarked to results from randomized controlled trials. All pretest-posttest effect sizes for disorder-specific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies that are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small.

Methodological issues in prediction of treatment outcome

Abstract Behavioral therapists are increasingly interested in identifying clients who fail to improve from their treatment. Behavioral researchers who know who fails in treatment, and why, are better able to modify their treatment regimes effectively and to delineate critical variables for matching clients to the most suitable treatment program. Unfortunately, progress in this type of research has been hampered by a number of common methodological problems. In this paper we review such problems and make a number of suggestions for future prediction research.

Are emotions frightening? An extension of the fear of fear construct ☆

Proposed in this paper is an expansion of the concept of fear of fear to include fear of other emotions (anger, depression, and positive emotions). In Study 1, initial evidence of the reliability and validity of a questionnaire designed to measure this construct, the Affective Control Scale, is provided. In Study 2, an analogue experiment of susceptibility to panic disorder was conducted. The ability of fear of anger, depression, and positive emotions to predict fear of laboratory-induced bodily sensations in a population with no history of panic attacks was demonstrated.

Predictors of Response to Cognitive-Behavioral Group Therapy for Social Phobia

Response to cognitive-behavioral group therapy for social phobia was assessed at posttest and 6-month follow-up in a sample of 62 clients (41 generalized subtype, 21 nongeneralized). Predictors assessed were depression, expectancy, personality disorder traits, clinician-rated breadth and severity of impairment, and frequency of negative thoughts during social interactions. Outcome measures included self-report questionnaires and behavioral tests of dyadic interaction and a public speech. Although no predictor was related to outcome across all domains of measurement, higher depression, more avoidant personality traits, and lower treatment expectancy were each related to poorer treatment response on one or more outcome criteria. Cognitive change was consistently associated with change on self-report symptom measures, but, contrary to expectation, lower rates of negative thinking at posttest did not predict better maintenance of treatment gains at follow-up.

Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale.

The reliability and validity of the Yale-Brown Obsessive-Compulsive Scale were examined according to a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). Internal consistency was acceptable but was improved by deletion of items concerning resistance to obsessions and compulsions. Inter-rater reliability was excellent, but test-retest reliability over an average interval of 48.5 days was lower than desirable. The YBOCS demonstrated good convergent validity with most other measures of OCD, but divergent validity vis à vis depression was poor. Analyses of new items assessing avoidance and the duration of obsession-free and compulsion-free intervals indicated that only the avoidance rating added meaningfully to the full scale score. In future research the authors recommend deletion of the resistance items and inclusion of the avoidance item to yield a revised 9-item YBOCS total score.

Training in Empirically Validated Treatments: What Are Clinical Psychology Students Learning?

Directors of clinical training (83%) and directors of internships with American Psychological Asso-ciation approval (55%) responded to a survey concerning empirically validated psychological treat-ments in which their students received training. Most programs provided supervised clinical experi-ence in a number of these treatments. However, over 20% of doctoral training programs failed toprovide minimal coverage of empirically validated treatments in didactic courses, and internshipprograms typically did not require that students be competent in any of these treatments beforecompletion of the program. The absence of didactic and clinical training in empirically validatedpsychodynamic therapies and interpersonal therapy was most marked. These findings suggest thatprograms need to be more attentive to teaching data-based treatments.PAUL CRITS-CHRISTOPH received his PhD in clinical psychology fromYale University in 1984. He is currently associate professor of psychol-ogy in psychiatry and director of the Center for Psychotherapy Researchat the University of Pennsylvania. At present he is studying the effects ofbrief dynamic psychotherapy and cognitive therapy for cocaine addic-tion and for generalized anxiety disorder and is examining the processof interpersonal psychotherapy and cognitive therapy for depression.ELLEN FRANK received her PhD from the University of Pittsburgh in1979. She is professor of psychiatry and psychology in the Departmentof Psychiatry at the University of Pittsburgh School of Medicine. Shedirects the Depression and Manic-Depression Prevention Program atWestern Psychiatric Institute and Clinic. Her treatment research hasfocused on the prophylaxis of recurrent mood disorders using interper-sonal psychotherapy, pharmacotherapy, and their combination.DIANNE L. CHAMBLESS received her PhD in clinical psychology fromTemple University in 1979. She is currently professor of psychology atThe American University. She conducts research on the psychopathol-ogy and cognitive-behavioral treatment of anxiety disorders and is par-ticularly interested in psychotherapy integration and the impact of in-terpersonal relationships on anxiety.CINDY BRODY received her BA in psychology from the University ofPennsylvania in 1991 and for 3 years was a research assistant at theCenter for Psychotherapy Research. She is currently a doctoral studentin clinical psychology at The American University. Her major researchinterests are in coping, interpersonal problems, and psychotherapy pro-cess and outcome.JORDAN F. KARP received his BA in psychology from Emory University in1992. He completed 2 years as a research associate in the Depression andManic-Depression Prevention Program at Western Psychiatric Instituteand Clinic. He is currently a medical student at the University ofPittsburgh.WE THANK David Barlow, Barry Wolfe, and Division 12 for assistance